Efficacy and Safety of Tumour Necrosis Factor-α Antagonists for Folliculitis Decalvans: A Retrospective Case-series Pilot Study
Keywords:folliculitis decalvans, infliximab, adalimumab, TNFα inhibitor, cicatricial alopecia
Folliculitis decalvans is a chronic inflammatory skin disease leading to scarring alopecia. Management of this disabling disease is difficult and no treatment is currently approved. Current knowledge regarding the pathogenesis of folliculitis decalvans suggests the benefit of using anti-tumour necrosis factor-α. This pilot study aimed to evaluate the clinical efficacy of anti-tumour necrosis factor-α for management of folliculitis decalvans. A single-centre retrospective pilot study included patients with refractory folliculitis decalvans treated by tumour necrosis factor-α inhibitors. An Investigator’s Global Assessment (IGA) score was designed and validated to assess the efficacy of the therapy. Response to treatment was considered good to excellent when an IGA ≤ 2 was obtained at month 12. Eleven patients were included, with a mean time from diagnosis of folliculitis decalvans to the introduction of infliximab (n = 9) or adalimumab (n = 2) of 8.55 ± 1.26 years. Nine patients had failed on at least 2 lines of systemic therapies before starting anti-tumour necrosis factor-α. The median IGA score at baseline was 3. At the end of follow-up, 5 patients were considered responders. Overall, the safety profile of anti-tumour necrosis factor-α was good. The results suggest that the clinical benefit of anti-tumour necrosis factor-α is obtained after at least 6 months of treatment. However, further prospective studies are needed to confirm these results.
Ross EK, Tan E, Shapiro J. Update on primary cicatricial alopecias. J Am Acad Dermatol 2005; 53: 1-37.
https://doi.org/10.1016/j.jaad.2004.06.015 DOI: https://doi.org/10.1016/j.jaad.2004.06.015
Whiting DA. Cicatricial alopecia: clinico-pathological findings and treatment. Clin Dermatol 2001; 19: 211-225.
https://doi.org/10.1016/S0738-081X(00)00132-2 DOI: https://doi.org/10.1016/S0738-081X(00)00132-2
Matard B, Cavelier-Balloy B, Reygagne P. Epidermal psoriasiform hyperplasia, an unrecognized sign of folliculitis decalvans: a histological study of 26 patients. J Cutan Path 2017; 44: 352-357.
https://doi.org/10.1111/cup.12892 DOI: https://doi.org/10.1111/cup.12892
Matard B, Donay JL, Resche-Rigon M, Tristan A, Farhi D, Rousseau C, et al. Folliculitis decalvans is characterized by a persistent, abnormal subepidermal microbiota. Exp Dermatol 2020; 29: 295-298.
https://doi.org/10.1111/exd.13916 DOI: https://doi.org/10.1111/exd.13916
Eyraud A, Milpied B, Thiolat D, Darrigade AS, Boniface K, Taieb A, Seneschal J Inflammasome activation characterizes lesional skin of folliculitis decalvans. Acta Derm Venerol 2018; 98: 570-575.
https://doi.org/10.2340/00015555-2924 DOI: https://doi.org/10.2340/00015555-2924
Chiarini C, Torchia D, Bianchi B, Volpi W, Caproni M, Fabbri P. Immunopathogenesis of folliculitis decalvans: clues in early lesions. Am J Clin Pathol 2008; 130: 526-534.
https://doi.org/10.1309/NG60Y7V0WNUFH4LA DOI: https://doi.org/10.1309/NG60Y7V0WNUFH4LA
Williamson D, Gonzalez M, Finlay AY. The effect of hair loss on quality of life. J Eur Acad Dermatol Venereol 2001; 15: 137-139.
https://doi.org/10.1046/j.1468-3083.2001.00229.x DOI: https://doi.org/10.1046/j.1468-3083.2001.00229.x
Rambhia PH, Conic RRZ, Murad A, Atanaskova-Mesinkovska N, Piliang M, Bergfeld W. Updates in therapeutics for folliculitis decalvans: a systematic review with evidence-based analysis. J Am Acad Dermatol 2019; 80: 794-801.e1.
https://doi.org/10.1016/j.jaad.2018.07.050 DOI: https://doi.org/10.1016/j.jaad.2018.07.050
Miguel-Gómez L, Rodrigues-Barata AR, Molina-Ruiz A, Martorell-Calatayud, Fernández-Crehuet P, Grimalt R, et al. Folliculitis decalvans: effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up. J Am Acad Dermatol 2018; 79: 878-883.
https://doi.org/10.1016/j.jaad.2018.05.1240 DOI: https://doi.org/10.1016/j.jaad.2018.05.1240
Vañó-Galván S, Molina-Ruiz AM, Fernández-Crehuet P, Rodrigues-Barata AR, Arias-Santiago S, Serrano-Falcón C, et al. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Acad Dermatol Venereol 2015; 29: 1750-1757.
https://doi.org/10.1111/jdv.12993 DOI: https://doi.org/10.1111/jdv.12993
Mihaljević N, Driesch P von den. Successful use of infliximab in a patient with recalcitrant folliculitis decalvans. J Dtsch Dermatol Ges 2012; 10: 589-592.
https://doi.org/10.1111/j.1610-0387.2012.07972.x DOI: https://doi.org/10.1111/j.1610-0387.2012.07972.x
Kreutzer K, Effendy I. Therapy-resistant folliculitis decalvans and lichen planopilaris successfully treated with adalimumab. J Dtsch Dermatol Ges 2014; 12: 74-76. DOI: https://doi.org/10.1111/ddg.12224_suppl
https://doi.org/10.1111/ddg.12224 DOI: https://doi.org/10.1111/ddg.12224
Shireen F, Sudhakar A. A case of isotretinoin therapy-refractory folliculitis decalvans treated successfully with biosimilar adalimumab (Exemptia). Int J Trichol 2018; 10: 240-241.
https://doi.org/10.4103/ijt.ijt_34_18 DOI: https://doi.org/10.4103/ijt.ijt_34_18
Alhameedy M, Alsantali A. Therapy-recalcitrant folliculitis decalvans controlled successfully with adalimumab. Int J Trichol 2019; 11: 241-243.
https://doi.org/10.4103/ijt.ijt_92_19 DOI: https://doi.org/10.4103/ijt.ijt_92_19
Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 1994; 6: 284-290.
https://doi.org/10.1037/1040-35126.96.36.1994 DOI: https://doi.org/10.1037/1040-35188.8.131.524
Iorizzo M, Starace M, Vano-Galvan S, Piraccini BM, Reygagne P, Rudnicka L, et al. Refractory folliculitis decalvans treated with adalimumab: a case series of 23 patients. J Am Acad Dermatol 2022; 87: 666-669.
https://doi.org/10.1016/j.jaad.2022.02.044 DOI: https://doi.org/10.1016/j.jaad.2022.02.044
Soglia S, Maione V, Bugatti M, Vermi W, Calzavara-Pinton P, Venturini M. Adalimumab for interleukin-1β-mediated chronic non-scarring scalp folliculitis: case report and literature review. J Dermatol 2022; 49: 157-160.
https://doi.org/10.1111/1346-8138.16106 DOI: https://doi.org/10.1111/1346-8138.16106
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Copyright (c) 2023 Aurore Dupont, Alexia Eyraud, Brigitte Milpied, Sylvie de Bataille, Eline Cassassa, Anne-Sophie Darrigade, Thomas Barnetche, Marie-Sylvie Doutre, Bruno Matard, Marie Beylot-Barry, Julien Seneschal
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